When the Client Is Not Seeking Help

Misuse of telephone and online counselling

Picture this: you are a counsellor on a crisis service, half an hour into a conversation with someone who says they’re struggling. You’ve been listening carefully, trying to make sense of what’s troubling them and what support they need. Although something about the interaction has made you uncomfortable, nothing they’ve said gives you an obvious reason to question why they’re there.

Then you hear sounds that make you wonder whether they are sexually stimulating themselves while talking to you. The conversation may have had nothing to do with sex, yet you’re now wondering whether the person you’ve been trying to support has been using your attention for sexual gratification.

Sometimes, by the end of the interaction, you are certain that the caller has sexually exploited you; at other times, you are left with a disturbing suspicion that you cannot resolve. Whether you know what happened or are still trying to make sense of it, it can be deeply upsetting to think that the care you offered in good faith may have been used to involve you in sexual activity without your knowledge or consent. You may go back over the conversation, trying to work out what happened, while still worrying that you’ve misjudged someone who genuinely needed help.

People who have worked in telephone and online video counselling services may recognise a couple of different kinds of presentations.

In some, the conversation becomes progressively more sexualised. A client begins with a plausible concern, perhaps about a relationship or an experience of sexual violence, but gradually introduces more explicit material. The details become increasingly graphic, and the counsellor may find that attempts to explore the person's distress or support needs keep bringing the conversation back to sexual content. Eventually, it becomes apparent that the caller may be seeking sexual gratification from the interaction.

Other presentations are much harder to recognise. The client might spend half an hour discussing something entirely plausible. The topic itself may never become particularly sexual, yet something about the interaction feels wrong. Perhaps the client seems unusually determined to keep the conversation going, or the worker notices something in their manner that they cannot quite explain. They get the “ick”. Then they hear breathing or other noises that suggest the person may be masturbating, and suddenly the entire conversation takes on a different meaning.

There can be a particularly unpleasant sense of having been manipulated and exploited. The worker has spent considerable time listening, responding thoughtfully - caring! - and trying to help someone who may have been using that professional attention for a very different purpose.

For something that people working in telephone services may recognise immediately, this phenomenon has received too little research attention. What research does exist, however, is revealing.

What does the research tell us?

An Australian study (Allan, Tilley & Hendriks, 2025) examined the experiences of 12 crisis telehealth clinicians working with sexual content. One of the study's major themes concerned what the researchers called disingenuous contacts, where callers appeared to be using the service for purposes other than seeking support, frequently involving sexual gratification. The study also documented participants’ experiences of sexual violation, including being drawn into sexualised interactions without their consent.

All 12 participants recognised this type of contact, and all nine female participants discussed masturbation or sexual role-play as features of these calls. The clinicians described hearing sounds suggesting masturbation, encountering repeated sexual scenarios and noticing callers attempting to elicit particular words or reactions from them.

The researchers documented the difficulty workers experienced in recognising what was happening. Some callers repeatedly introduced innuendo or explicit material, while others appeared to construct interactions designed to keep the counsellor engaged. Clinicians described relying partly on experience to distinguish genuine disclosures from sexually motivated contacts.

One participant described feeling deeply violated after recognising that a caller had involved them in sexual behaviour without their consent. Another reflected on how workers sometimes remained in uncomfortable interactions longer than they wanted to because they were trying to fulfil their responsibilities to the caller and their organisation. Having worked in several mental health call centres, I recognise both experiences with depressing familiarity.

The study was small and exploratory, with ten of its 12 participants employed by the same service. Its findings therefore cannot establish how frequently these calls occur across Australian crisis services. One participant estimated that around one in ten calls was disingenuous, but this was a personal estimate rather than a measured prevalence rate.

Its value lies in documenting experiences that workers may recognise from their own practice but rarely see examined in research, including the sexual violation itself and the professional obligations that can make it difficult to end a call.

This is not an entirely new problem. As early as 1980, Matek was writing about the challenges of supporting crisis-line volunteers who encountered callers masturbating during telephone conversations. Baird, Bossett and Smith (1994) subsequently published a paper specifically examining sexually abusive calls to telephone crisis lines and proposing a technique for responding to them.

More recently, Nason and colleagues (2024) examined inappropriate interactions with a web-based sexual assault hotline. Their analysis revealed how difficult it can be to distinguish genuine disclosures from potentially exploitative interactions, even for experienced practitioners and researchers. The study also highlighted the importance of supporting workers to navigate ambiguity, establish appropriate boundaries and respond without unnecessarily discouraging people seeking help.

This literature suggests that sexually motivated misuse has been recognised in telephone and online support services for decades. Yet we still have too little systematic knowledge about its prevalence, the different ways it occurs or the effectiveness of organisational responses, particularly in contemporary video counselling.

When listening becomes participation

There is an important difference between hearing about sexual behaviour and being made part of it.

Counsellors do listen to sexual material, more so for workers depending on context (for example, those working in gender-based violence). Someone may describe a sexual interaction in considerable detail because they are trying to understand what happened to them. Another client may need to discuss sexual functioning, intrusive sexual thoughts, shame or behaviour they find troubling. The presence of explicit content tells us little on its own about the purpose of the conversation.

The Australian research by Allan and colleagues (2025) identified this as a significant professional dilemma. Clinicians were concerned that genuine callers, particularly those who were distressed, awkward or discussing stigmatised sexual experiences, could be mistakenly identified as misusing the service.

The distinction lies in what the other person is doing: deliberately using a counselling interaction for sexual gratification without the counsellor's knowledge or consent. In some cases, the sexual content is overt. In others, the worker may be having an apparently ordinary conversation while the client engages in sexual behaviour without their knowledge.

Some older literature on obscene telephone calling is useful here. Warner (1988) described obscene telephone calls as an “aural assault”, focusing on the way callers manipulated ordinary telephone conventions to gain access to another person before turning the interaction sexual.

A counselling service offers an unusual variation on this dynamic. The worker is not simply someone who happened to answer the telephone or join a video meeting. They are there specifically to listen. Their training encourages them to remain calm when somebody discloses disturbing or explicit material, and they will usually begin from an assumption that the person speaking to them is doing so in good faith.

In telephone counselling, the practitioner cannot see what is happening. Video counselling offers visual information, but only within the limited view of the camera. A person may appear to be participating in an ordinary therapeutic conversation while engaging in sexual behaviour outside that view. At other times, the counsellor may be confronted with deliberate exposure or overt sexual behaviour on camera.

The professional role itself can therefore become vulnerable to exploitation. Someone may be able to maintain the counsellor's attention for an extended period precisely because the counsellor believes they are providing care.

The difficulty of knowing what is happening

Recognition is not straightforward, particularly when the behaviour is concealed.

Sometimes there are fairly obvious indicators. The person repeatedly returns to explicit sexual material, introduces innuendo or appears to be seeking particular reactions from the counsellor. In other cases, the worker has little more than an uncomfortable feeling, perhaps accompanied by unusual sounds, movements or a sense that the conversation is being prolonged without any clear therapeutic purpose.

The “ick” is absolutely worth paying attention to, although it is not evidence of sexual intent in itself.

Our responses to an interaction can alert us to something we have not yet consciously identified. Equally, discomfort can reflect our own experiences, assumptions or uncertainty. A counsellor might feel unsettled by a genuine disclosure involving unfamiliar sexual behaviour, for example, or misinterpret changes in breathing associated with distress.

Allan and colleagues (2025) found that clinicians were acutely aware of this dilemma. Their participants described both the experience of recognising sexually motivated calls and the risk of incorrectly dismissing genuine callers.

The challenge is to remain curious without requiring workers to disregard their own discomfort.

It may help to consider what is happening in the interaction rather than attempting to establish the client's motives. If a person repeatedly steers the conversation towards sexual material, the counsellor can clarify what they are seeking help with and redirect the discussion towards their support needs.

The more concealed interactions are harder. A client may continue to discuss a legitimate topic while the counsellor becomes increasingly uncomfortable. There may be no obvious conversational pattern to challenge, and asking about the purpose of the contact may produce a totally plausible answer.

These situations present a genuine challenge for organisations. Services have a responsibility to remain accessible to people experiencing distress, including those who may struggle to communicate about sexual experiences, while also considering the safety and wellbeing of their workers. When sexually motivated behaviour is suspected but cannot be established with certainty, finding an appropriate response can be particularly complex.

Depending on the service context, this might include opportunities to clarify the purpose of an interaction, seek timely consultation or make a considered decision to end contact when there are reasonable concerns about sexually exploitative behaviour. Ideally, counsellors would have access to clear guidance and timely support, including a shared understanding of when and how an interaction can be safely ended.

A counsellor should not have to remain in a potentially sexually exploitative interaction. The responsibility for navigating these difficult decisions should not rest with individual workers alone.

What happens to the worker?

Much of the literature on crisis work understandably focuses on exposure to distress, suicidality and traumatic stories. Concepts such as vicarious trauma, compassion fatigue and burnout have given us ways of understanding some of the cumulative costs of this work.

They do not entirely describe what can happen during a sexually motivated interaction.

If the counsellor has unknowingly been incorporated into somebody's sexual activity, they have not simply witnessed another person's experience. Something has happened directly to them.

The Australian study by Allan and colleagues (2025) provides valuable insight. Participants described anger, helplessness and discomfort, alongside the sense of having been sexualised at work without their consent. Female clinicians reported these experiences disproportionately, and some participants described frustration with organisational responses that treated sexually motivated calls as an expected part of the job.

I recognise some of those experiences from my own years working in telephone counselling services, including services supporting people who had experienced sexual violence. I remember the discomfort of realising that a caller may have been masturbating while I was trying to help them, and the frustration and shame that sometimes followed. There was the sexual violation itself, but also the feeling that I had been manipulated through the very skills I was expected to bring to my work.

What made some of those experiences harder was not knowing whether the organisation would support me. Policies were sometimes unclear, and even when procedures existed, they were not always applied consistently. It could be difficult to know what you were permitted to do, particularly when the interaction was ambiguous. The uncertainty did not necessarily end when you hung up.

There is something particularly troubling about experiencing sexual violation while working in a service dedicated to supporting people who have experienced sexual violence. Counsellors understand the importance of consent, power and safety. We spend considerable time helping clients recognise when their boundaries have been crossed. Yet the professional environment does not always provide workers with the same clarity about their own experiences.

Counselling also requires a particular kind of interpersonal openness. To listen well, we allow ourselves to be affected by what another person tells us. We pay attention to their emotional experience, remain receptive to uncertainty and offer genuine human engagement. Those qualities make therapeutic relationships possible, but they also create vulnerability when someone deliberately exploits them.

The consequences may extend beyond the individual interaction. A worker might begin questioning their judgement, become more guarded with future clients or find themselves struggling to remain open when someone genuinely needs to discuss sexual trauma.

The impact will differ between people, and it should not be assumed that every sexually motivated interaction produces lasting harm. But workers deserve an opportunity to make sense of their experience without having it minimised or treated as an inevitable inconvenience of remote counselling.

The organisational challenge: balancing access and worker safety

The response a counsellor receives after one of these incidents can significantly shape how they understand and recover from it.

An organisation may have a policy about sexually inappropriate clients, but that does not necessarily mean workers know how to apply it. The more ambiguous situations are particularly difficult. What happens when the counsellor suspects masturbation but cannot be certain? Is the worker permitted to terminate the session? Should they consult a supervisor first? What if the client has disclosed suicidality or sexual assault?

These questions are difficult enough during a live interaction. They become harder when staff have received inconsistent advice or have seen colleagues treated differently for making similar decisions. A policy that exists on paper but is not understood, practised or consistently supported offers limited protection.

There can also be an uncomfortable tension between the organisation's commitment to accessible, non-judgemental care and its responsibility to protect workers. This is particularly complex for publicly funded services, which may operate under funding agreements, eligibility requirements and service commitments that limit their discretion to refuse or discontinue support. Crisis services are often designed to be accessible to people experiencing significant distress, including those whose behaviour or communication may be difficult to interpret. Decisions about ending contact can therefore involve clinical risk, service obligations and contractual considerations alongside worker safety. The situation becomes more difficult when workers worry that ending a concerning interaction might be interpreted as a failure of empathy or professional competence.

These are genuine tensions for organisational leaders, particularly when a caller's intentions are unclear. An organisation may be committed to protecting its workers while also being concerned about withdrawing support from someone who could be vulnerable or at risk. There may be no simple procedure capable of resolving every situation, particularly when the person's intentions remain unclear.

Organisations can explore how these competing responsibilities are understood in practice, what guidance workers need when making difficult decisions and how reasonable professional judgement can be supported when certainty is unavailable.

The response after an incident matters just as much. A worker who reports feeling sexually violated needs to know that their experience will be taken seriously, even when the client's intentions cannot be conclusively established.

Allan and colleagues (2025) found that some clinicians experienced limited organisational preparation and felt insufficiently supported in managing sexually motivated contacts. Their findings suggest that individual workers have sometimes been left to develop their own ways of recognising and responding to these situations.

For organisations, the opportunity is to bring these experiences into conversations about clinical practice, worker wellbeing and service responsibilities. A private practitioner, a counsellor employed by a large crisis service and an EAP contractor may have very different resources and obligations, but all can benefit from clarity about where responsibility sits and what support is available.

These questions invite reflection on organisational culture as well as clinical procedure.

Supervision as a place for safety and reflective practice

Clinical supervision offers an important opportunity to explore these experiences, although the way we approach them matters.

Supervisors are accustomed to asking questions about therapeutic process. We might naturally want to know when the counsellor first sensed something was wrong, what cues were present and what they could do differently next time.

Those questions may eventually be useful, but beginning there risks turning another person's deliberate behaviour into an examination of the worker's clinical performance.

A more supportive starting point is to understand what happened from the counsellor's perspective. What was the experience like for them? How did they understand what was happening at the time, and has that understanding changed since? What support did they receive afterwards, and was it what they needed?

There may be shame or embarrassment to work through, particularly if the counsellor feels they should have recognised the situation sooner. Some may be angry with themselves for remaining in the interaction, while others are more affected by the organisation's response than by the interaction itself.

Supervision can provide room for these different experiences without assuming what the worker ought to feel.

As the conversation develops, there may be opportunities to reflect on professional judgement and boundaries. A counsellor who experienced the “ick” but continued with the interaction might want to explore what influenced that decision. Such reflection is most useful when it is grounded in respect for the counsellor's judgement and recognises the limits of what they could reasonably have known.

There is also value in considering what the counsellor needs to feel supported in future interactions, and how supervision can help restore confidence in the professional capacities that may have been shaken by the experience.

Supervision has a role beyond individual practitioner development.

When several workers describe similar experiences, or when the same uncertainties repeatedly arise in supervision, the organisation may have something important to learn. Patterns of confusion about policy, inconsistent managerial responses or reluctance to report incidents can reveal systemic questions that are unlikely to be resolved through individual skill development alone.

Organisational supervision and reflective practice can create opportunities for teams and leaders to examine these patterns together. The conversation might explore how the organisation balances accessibility with worker safety, whether its procedures reflect the realities of remote counselling, and what staff need from leadership when they encounter sexually exploitative behaviour.

This work is particularly valuable when it allows people at different levels of the organisation to think together without immediately moving towards blame or defensiveness.

There is still much we do not know about the prevalence of sexually motivated misuse across telephone services, video counselling, EAPs and private practice. The available research is limited, but the experiences it documents deserve attention.

For me, the central question is how we create working environments in which counsellors can continue to offer the openness and care their clients need, while knowing that their own safety, dignity and professional judgement matter too.

That is a question worth continuing to explore in supervision, in organisational reflective practice and in the wider counselling profession.

We have two groups starting soon, one for Early Career Counsellors and another for DFV, SA and Trauma. Check out all our supervision options here.

If your team is navigating complex client interactions, worker wellbeing concerns or questions about how organisational policies operate in practice, we welcome a conversation about how supervision might support your work. Learn more about organisational supervision partnerships here.

References

Allan, B., Tilley, P. J. M., & Hendriks, J. (2025). Sexual content in Australian crisis telehealth. Clinical eHealth, 8, 103–116. https://doi.org/10.1016/j.ceh.2025.03.003

Baird, B. N., Bossett, S. S., & Smith, B. J. (1994). A new technique for handling sexually abusive calls to telephone crisis lines. Community Mental Health Journal, 30(1), 55–60. https://doi.org/10.1007/BF02188875

Matek, O. (1980). Teaching volunteers of a crisis phone service to respond therapeutically to callers with sex problems. Journal of Sex Education and Therapy, 6(2), 24–28. https://doi.org/10.1080/01614576.1980.11074672

Nason, J. A., Moylan, C. A., Nelson, A., Munro-Kramer, M. L., Fedewa, T., & Campbell, R. (2024). Pranks, obscene chatters, and ambiguous content: Exploring the identification and navigation of inappropriate messages to a web-based sexual assault hotline. Journal of Child Sexual Abuse, 33(2), 183–203. https://doi.org/10.1080/10538712.2024.2319084

Warner, H. (1988). Aural assault: Obscene telephone calls. Qualitative Sociology, 11, 83–98.